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GQG GLOBAL UCITS ICAV

APPLICATION FORM

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GQG GLOBAL UCITS ICAVApplication Form

IMPORTANT — Investors should ensure that the original application form is returned by post to the Administrator at the

address below. Failure to return the original application form and supporting documentation will delay the payment of redemption proceeds (and dividends/distributions if applicable).

— No redemption payment will be made until the original application form has been received and the Administrator is satisfied that all necessary anti-money laundering checks have been completed in full.

— Investors should ensure the section headed “SIGNATURE” on page 28 has been signed before returning this application form to the Administrator.

— Investors should ensure all other relevant signature pages have been reviewed, completed and signed as appropriate, see pages 7, 26, 35, 39 for reference.

— Investors are reminded to read the corresponding subscription/redemption forms before completing this application form.

— Should you have any queries in relation to your account setup, or wish to obtain your account name and number for the purposes of submitting a Subscription, please contact the Fund Administrator, Northern Trust, using the details provided below.

PLEASE FAX COMPLETED APPLICATION FORM TO THE FUND ADMINISTRATORFACSIMILE +353 1 542 2133

OR EMAIL TO:EMAIL [email protected]

(Please refer to APPENDIX I for “Terms and Conditions of Service for instructions issued to the Administrator via email”)

OR POST HARD COPY TO (in any case post hard copy):Northern Trust

City East Plaza - Block A, Towlerton, Ballysimon Road Limerick, Ireland V94 X2N9

For fund administrator inquiries, please contact Northern Trust at:EMAIL [email protected], or

TELEPHONE +353 1 434 5024

For general questions or Key Investor Information Document (KIID) related requests, please contact the GQG Client Services team at:

EMAIL [email protected], orTELEPHONE 001 754 218 5500 (USA)

Please ensure that you have read the Prospectus and the Key Investor Information Documents (the “KIIDs”) before completing this Application Form. The KIIDs are available at the Investment Manager’s website at gqgpartners.com.

Defined terms used in this Application Form are those used in the Prospectus (unless the context otherwise requires).

Your personal information will be handled by the Administrator or its duly appointed delegates as Data Processor for the GQG Global UCITS ICAV (the “ICAV”) in accordance with the General Data Privacy Regulation (Regulation (EU) 2016/679) (“Data Protection Legislation”). Your information provided herein will be processed for the purposes of complying with Data Protection Legislation and this may include disclosure to the Irish Revenue Commissioners.

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APPLICATION FORM


Please complete this Application Form in blue or black ink using BLOCK CAPITAL LETTERS.

This Application Form, together with the Money Laundering Verification Requirements and the Declaration of Irish Residence outside Ireland, constitutes your agreement to subscribe for Shares in the Fund. Please post, fax or email this Application Form to the contact details on the cover page. Investors should ensure that the original application form is returned by post to the Administrator. Failure to return the original application form and supporting documentation will delay the payment of redemption proceeds (and dividends/distributions if applicable).

Incomplete Application Forms (where compulsory information* has not been provided) may be rejected and subscription monies received may be returned. If an application is rejected, the Administrator at the cost and risk of the Applicant will, subject to any applicable laws, return subscription monies or the balance thereof, without interest, expenses or compensation by electronic transfer to the account from which it was paid.

NAME(S) FOR REGISTRATION (BLOCK CAPITALS)*SHAREHOLDER 1 SHAREHOLDER 2

First Name & Family Name/Company Name* First Name & Family Name/Company Name

Street 1* Street 1

Street 2* Street 2

Town/Country/Postcode* Town/Country/Postcode

Contact Telephone Number* Contact Telephone Number

Contact Fax Number & Email Address* Contact Fax Number & Email Address

SHAREHOLDER 3 SHAREHOLDER 4

First Name & Family Name/Company Name First Name & Family Name/Company Name

Street 1 Street 1

Street 2 Street 2

Town/Country/Postcode Town/Country/Postcode

Contact Telephone Number Contact Telephone Number

Contact Fax Number & Email Address Contact Fax Number & Email Address

Mailing Address (if different from the address of the first name’s holder)

By ticking the box opposite, I hereby consent to the provision of contract notes, statements and other reports, by secured or encrypted electronic transmission, which may be issued from time to time by the Administrator in respect of my holdings in the Fund.

Northern Trust (“NT”) requires a standard four days turnaround for application completion. Please reach out to NT if you require assistance with placing trades sooner.

Please contact NT after four days to confirm your account number before submitting your initial subscription form.

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APPLICATION FORM


BANKING DETAILS

THIS SECTION MUST BE COMPLETED BY ALL APPLICANTS*

BANK ACCOUNT DETAILS FOR SETTLEMENT OR REDEMPTION

Name of Bank:

Account Name:

Address of Bank:

Account Number:

Sort Code:

IBAN:

Swift Code: Reference Code:

NOTE No third party payments will be undertaken.

NOTE Any subsequent changes to bank account details will require further instruction along with supporting documents to be given to the Administrator.

NOTESa. Requests for redemption or distribution payments (see Dividend/Distribution Requirements) to be made by

telegraphic transfer will be subject to bank charges. Such charges will normally be payable by the Shareholder although the ICAV has the discretion to determine that these charges should be borne by the ICAV or the relevant Sub-Fund.

b. The Base Currency of the Sub-Fund and the designated currency of any Shares will be set out in the Prospectus. Applications for Shares shall be accepted in the Base Currency of the relevant Sub-Fund or the designated currency of the relevant Share Class. At the discretion of the ICAV, subscriptions may be accepted in currencies other than the Base Currency.

c. Any subscription proceeds paid in currencies other than the Base Currency of the relevant Sub-Fund or the designated currency of the relevant Share Class will be converted into that currency at prevailing exchange rates. This foreign exchange transaction will be arranged by the Administrator at the cost and risk of the relevant investor.



APPLICATION FORM


DISTRIBUTION/DIVIDEND REQUIREMENTS

I/We would like our distribution: Re-invested Paid by telegraphic transfer

Distributions paid by telegraphic transfer will be paid to the account specified above. Should you require your distribution to be paid to another account, please enter the banking details below. Please note if no option is indicated, such dividend payments will be reinvested. Distributions due will automatically be re-invested if you have failed to provide satisfactory evidence of your identity in accordance with the Administrator’s anti-money laundering procedures notwithstanding any election to the contrary by you.

Name of Bank:

Account Name:

Address of Bank:

Account Number:

Sort Code:

IBAN:

Swift Code: Reference Code:

NOTE No third party payments will be undertaken.

AGENT DETAILS

Contact Name:

Agent Name:

Address:

Contact Fax Number: Contact Phone Number:

VAT Registration Number:

Regulator: Regulator Approval Number:

Agent’s Stamp:

Agency Number: Commission Terms Agreed with the ICAV Promoter:



APPLICATION FORM


RETURN OF VALUES (INVESTMENT UNDERTAKINGS) REGULATIONS 2013

The ICAV must collect additional information in order to satisfy Return of Values (Investment Undertakings) Regulations 2013 (S.I. 245 of 2013). Therefore any individual, company or any unincorporated body of persons which are an Irish resident or ordinarily Irish resident must provide the following additional information:

Tax Identification Number (TIN)/PPS Number:

Any one of the following additional documents is required to verify the TIN or PPS Number (either a copy or the original is sufficient):

P60P45P21 Balancing StatementPayslip (where employer is identified by name or tax number)Drug Payment Scheme CardEuropean Health Insurance CardTax AssessmentTax Return FormPAYE Notice of Tax CreditsChild Benefit Award Letter/BookPension Book Social Services CardPublic Services Card

In addition, any printed documentation issued by the Revenue Commissioners or by the Department of Social Protection which contain your name, address and tax reference number will also be acceptable. In the case of joint account holders, the additional documentation is required for each applicant.

Your personal information will be handled by the Administrator or its duly appointed delegates as Data Processor for the ICAV in accordance with the Data Protection Legislation. Your information provided herein will be processed for the purposes of complying with the Return of Values (Investment Undertakings) Regulations 2013 and this may include disclosure to the Irish Revenue Commissioners.



APPLICATION FORM


DUE DILIGENCE DOCUMENTATION

Due Diligence Documentary Requirements in accordance with The Criminal Justice (Money Laundering and Terrorist Financing) Act, 2010 (The ‘CJA 2010’) as amended and updated by The criminal Justice Act 2013 (The ‘CJA 2013’).

1. Guide to completing this form.

Part I — This section must be completed by all applicants.

Part II — Please provide the due diligence documentation outlined in this section.

2. Certification of Documents — Required for High Risk Countries

Certified copies of personal identification documents and corporate documentation are required for certain identified investors. Documents must be a ‘certified true copy of original’.

In terms of certifying a document as a true copy, certification means that there is an original signature on the document from a suitable person.

Suitable persons include:

— An authorised signatory of a Regulated Financial Institution or Credit Institution.

— An authorised signatory of a Financial Adviser.

— A Justice of the Peace.

— A Notary Public or Practicing Solicitor.

— A Practicing Chartered or Certified Public Accountant.

— A Medical Professional.

— A person authorised to sign on behalf of an Embassy or a Consul.

— A Police Officer.

Certification of each document should include:

— A signed statement confirming that this document is a true and accurate copy of the original document as seen by the person certifying the document.

— The name (in block capitals), occupation and contact details (address, telephone number and email address) of the person certifying the document, as a true copy of the original document.

— The date of certification of the document, as a true copy of the original document.

Note 1: Where the document, being certified as a true copy of the original document, contains a photograph, the person certifying the document as a true copy should also confirm that this a true likeness of the person named in the document.

Note 2: The document being provided as a true and accurate copy of the original document must include a wet ink signature of the person certifying the document as a true and accurate copy of the original document (i.e. no scanned or photocopied copies of the document being certified as a true copy of the original document, can be accepted).

Note 3: For multiple page documents, the certifier should sign or initial each page of the copy and confirm on the first or last page of the document the actual number of pages in the document.

Note 4: Where available, the statement of certification as a true copy of the sighted original should be accompanied by the professional stamp or seal of the certifier.

Note 5: When certifying documents as true copies, the certifier should not be a close family member of, or have any apparent or potential conflicts of interest with, the investor.

3. English Translations

Where due diligence documents are provided in a language other than English, the prospective investor should, at the same time, provide a relevant extract translated by an independent source confirming also the adequacy of the foreign language documents.



APPLICATION FORM


DUE DILIGENCE DOCUMENTATION — INVESTOR TYPEPlease tick investor type below (please note, investor type indicates the documents required to open account):

Private/Unlisted Company Charities

Partnership Trusts/Foundations

Listed Company Collective Investment Scheme/Fund

Subsidiary of a Listed Company School, College or University

Regulated Credit or Financial Institution Pension Schemes

Nominee Company Trade Unions

Government Body or Public Authority Church

Individual Other — Please specify:

Please confirm whether you are a Politically Exposed Person

A Politically Exposed Person (‘PEP’) means an individual (or family member or close associate of such individual) who is, or has, at any time in the preceding 12 months, been entrusted with a prominent public function.

DUE DILIGENCE DOCUMENTATION — LEVERAGE ACROSS INVESTMENTSI hereby authorise NTIFASIL (the Administrator) to leverage the due diligence documentation provided for the purposes of compliance with applicable regulatory requirements across all investments which I currently hold/may hold in the future across all funds which are administered by NTIFASIL.

DUE DILIGENCE DOCUMENTATION — ULTIMATE BENEFICIAL OWNERUltimate Beneficial Owners are individuals who directly or indirectly hold ownership of 25% or more of the shares or voting rights in an entity, or otherwise exercise control over the management of the entity.

NAME ADDRESS % OWNERSHIP NATIONALITY DATE OF BIRTH

Declaration — I/We declare that the information contained in this form and the attached documentation, if any, is true and accurate to the best of my/our knowledge and belief.

Signature 1 Print Name Date






APPLICATION FORM


DUE DILIGENCE DOCUMENTATION — REQUIREMENTSPart II — Due Diligence Requirements

Outlined below is guidance on the documentation which the Fund/ICAV Manager and Northern Trust (as Administrator) will require when undertaking due diligence to establish the identity of an investor and verify same to the extent warranted by risk.

The Fund/ICAV Manager and Administrator hereby reserve the right to request such further information and/or documentation from investors as is necessary from time to time to satisfy Irish regulatory requirements.

EXAMPLES OF PHOTOGRAPHIC IDENTITY DOCUMENTATION — Current passport.

— Current driving licence.

— Current national identity card.

— Current identification form with the photo signed by a police officer or equivalent.

— Social welfare/revenue card or any identity document with a photographic identity issued by a government department.

EXAMPLE OF PROOF OF ADDRESS — Bank statements/credit card statements.

— Utility bill.

— Household/motor insurance certificate and renewal notices.

— Correspondence from local authorities.

— Correspondence from the revenue commissioners or equivalent.

— Correspondence from any government body.

— Driving licence which confirms the address provided it has not also been used to satisfy the photographic identity requirement above.

— Payslip or salary advice dated within the previous 6 months.

— Confirmation of address from a lawyer or financial institution.

NOTE All documentation must reflect the current residential address and must be dated within the previous 6 months other than in the case of an official document known to be issued only or typically at fixed intervals of more than 6 months, in which case such document may be accepted during that period, to a maximum of 12 months (e.g. correspondence from local authorities).

LETTER OF ASSURANCEPlease contact Northern Trust for a template letter of assurance if required.

NOTE Investors are required to notify the Fund/ICAV Manager and Northern Trust of any changes to the AML information which was previously provided (e.g. changes in directors/controllers or beneficial ownership).



APPLICATION FORM


REGULATED CREDIT OR FINANCIAL INSTITUTIONWhere the applicant is a Regulated Credit or Financial Institution from one of the above referenced Prescribed Countries:

1. Please provide proof of regulation.

Where the applicant is a Regulated Credit or Financial Institution but is not regulated in a Prescribed Country please provide the following confirmations/documentation:

1. Full name of the company.

2. Registered number of the company.

3. Registered legal address and principal business address of the company.

4. Details of Directors of the company.

5. Details of any Beneficial Owner beneficially entitled to more than 25% of the share capital, profit or voting rights or otherwise exercising control over the management of the company.

NOTE Where the Beneficial Owner is a corporate entity, Northern Trust requires details of the ultimate Beneficial Owners (this can be demonstrated through an organisation chart signed by an authorised signatory or shareholder register confirming the identity of the ultimate Beneficial Owner).

6. Confirmation as to whether the company is investing on its own behalf or on behalf of underlying investors and (as applicable) confirmation of any underlying investor who is a Beneficial Owner of the proposed investment.

PRESCRIBED COUNTRIES (i.e. jurisdictions where a presumption of comparability with Ireland may be made)Australia, Austria, Belgium, Brazil, Bulgaria, Canada, Channel Islands, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hong Kong, Hungary, Iceland, India, Ireland, Isle of Man, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Mexico, Netherlands, Norway, Poland, Portugal, Romania, Singapore, Slovakia, Slovenia, South Africa, South Korea, Spain, Sweden, Switzerland, United Kingdom, and United States.

The Dutch overseas territories of Netherlands Aruba, Curaçao, Sint Maarten, Bonaire, Sint Eustatius and Saba.

The French overseas territories of Mayotte, New Caledonia, French Polynesia, Saint Pierre and Miquelon, and Wallis and Futuna.

DEEMED HIGH RISK COUNTRIESAfghanistan, Albania, Angola, Azerbaijan, Bahamas, Belarus, Belize, Benin, Bolivia, Bosnia and Herzegovina, Burma (Myanmar), Burundi, Cambodia, Cape Verde, Central African Republic, Chad, China, Colombia, Comoros, Congo Democratic Republic, Congo Republic, Costa Rica, Cyprus, Dominican Republic, Ecuador, Egypt, El Salvador, Equatorial Guinea, Eritrea, Ethiopia, Ghana, Guatemala, Guinea, Guinea-Bissau, Haiti, Honduras, India, Iraq, Ivory Coast (Côte d’Ivoire), Jamaica, Jordan, Kazakhstan, Laos, Latvia, Lebanon, Liberia, Libya, Liechtenstein, Macau, Maldives, Marshall Islands, Mauritania, Mexico, Moldova, Monaco, Montenegro, Morocco, Myanmar (Burma), Nauru, Nicaragua, Nigeria, Pakistan, Palestinian Territories, Panama, Peru, Russia, Saint Kitts and Nevis, Saudi Arabia, Senegal, Serbia, Seychelles, Sierra Leone, Somalia, South Sudan, Sudan, Tajikistan, Tanzania, Tunisia, Turkey, Uganda, United Arab Emirates, Uzbekistan, Vanuatu, Venezuela, Yemen, and Zimbabwe.

NOTE Northern Trust reviews the risks associated with all locations on a regular basis. The risk associated with a location may change over time. Northern Trust reserves the right to apply a different risk rating than shown in this document.



APPLICATION FORM


7. One or more of the following:

— Extract from the relevant company registry providing details of the company; and/or

— Copy of the certificate of incorporation or equivalent of the company; and/or

— Copy of the Memorandum and Articles of Association or equivalent of the company; and/or

— Copy of the latest audited financial statements of the company.

Where the applicant is domiciled in an aforementioned high risk jurisdiction, the following is also required:

8. Photographic identity document and proof of address for 2 directors of the company.

9. Due diligence documentation (by reference to the legal form of the entity) for any Beneficial Owner beneficially entitled to more than 25% of the share capital, profit or voting rights or otherwise exercising control over the management of the company.

10. Where the company is investing on behalf of underlying investors, due diligence documentation (by reference to the legal form of the investor) for any Beneficial Owner of the proposed investment.

Where the applicant is domiciled in an aforementioned high risk jurisdiction, documentation should be certified as true copies of the original.

NOMINEE COMPANYWhere the applicant is a Regulated Nominee Company of a Credit or Financial Institution from one of the above referenced Prescribed Countries:


Where the applicant is an Unregulated Nominee Company of a Regulated Credit or Financial Institution from one of the above referenced Prescribed Countries please provide the following:

1. Letter of Assurance from the Regulated Credit or Financial Institution.

2. Proof of regulation for the Regulated Credit or Financial Institution.

OR

Please provide the following confirmations/documentation:

1. Full name of the Nominee Company.

2. Registered number of the Nominee Company.

3. Registered legal address and principal business address of the Nominee Company.

4. Details of the directors of the Nominee Company.

5. Proof of regulation for the Regulated Parent Company.

6. Identify any beneficial owner of the investment through the Nominee Company.


— Extract from the relevant company registry providing details of the Nominee company; and/or

— Copy of the certificate of incorporation or equivalent of the Nominee Company; and/or

— Copy of the Memorandum and Articles of Association or equivalent of the Nominee Company; and/or

— Copy of the latest audited financial statements of the Nominee Company.



APPLICATION FORM



8. Photographic identity document and proof of address for 2 directors or one director and one authorised signatory of the Nominee Company.

9. Due diligence documentation (by reference to the legal form of the entity) for any Beneficial Owner of the Nominee Company.


LISTED COMPANYWhere the applicant is a company listed on a regulated financial market in an EEA (European Economic Area) State or a regulated financial market in a place other than an EEA State, being a place that imposes on companies whose securities are admitted to trading on the market disclosing requirements consistent with legislation of the European Communities.

1. Please provide proof of listing.

Where the applicant is not a Listed Company on an above referenced regulated financial market please provide the following confirmations/documentation:

1. Proof of listing of the company.

2. Full name of the company.

3. Registered number of the company.

4. Registered legal and principal business address of the company.

5. Details of the directors of the company.

6. Details of any beneficial owners who own more than 25% of the share capital, profit or voting rights or exercise control over management of the company.









9. Photographic identity document and proof of address for 2 directors or one director and one authorised signatory of the company.




APPLICATION FORM


11. Where the company is investing on behalf of underlying investors due diligence documentation (by reference to the legal form of the entity) for any Beneficial Owner of the proposed investment.


SUBSIDIARY OF A LISTED COMPANYWhere the applicant is a Subsidiary of a Company listed on a regulated financial market in an EEA (European Economic Area) State or a regulated financial market in a place other than an EEA State, being a place that imposes on companies whose securities are admitted to trading on the market disclosing requirements consistent with legislation of the European Communities.

1. Full name of the subsidiary company.

2. Registered number of the subsidiary company.

3. Registered legal and principal business address of the subsidiary company.

4. Details of the directors of the subsidiary company.

5. Details of any beneficial owners who own more than 25% of the share capital, profit or voting rights or exercise control over management of the subsidiary company.











10. Where the company is investing on behalf of underlying investors, due diligence documentation (by reference to the legal form of the entity) for any Beneficial Owner of the proposed investment.


GOVERNMENT/PUBLIC BODYWhere the applicant is a Government Body or Public Authority in Ireland:

1. Please provide background information sourced from a reliable source (e.g. copy of the legal instrument establishing the government body/public authority.



APPLICATION FORM


Where the applicant is not a Government Body or Public Authority in Ireland, please provide the following confirmations/documentation:

1. Full name of the government body or public authority.

2. Nature and status of the government body or public authority.

3. Registered legal address of the government body or public authority.

4. Details of the home state of the public authority and details of the nature of its relationship with the public authority.

5. Details of the ownership of the public authority.

6. Names of the main officials of the government body or public authority.

7. Appropriate background information on the government body or public authority.


8. Photographic identity document and proof of address for 2 officials of the government body or public authority.

9. Copy of the audited financial statements of the government body or public authority.


PENSION SCHEMEWhere the applicant is an Employee/Superannuation or similar scheme in one of the above referenced Prescribed Countries please provide the following confirmations from the trustees of the scheme:

1. Confirmation that the Employee/Superannuation (or similar scheme) provides for retirement benefits to employees.

2. Confirmation that contributions of the Employee/Superannuation scheme are made by deduction from wages.

3. Confirmation that the rules of the Employee/ Superannuation scheme do not permit a member’s interest under the scheme to be re-assigned.

Where the applicant is not an Employee/Superannuation or similar scheme in one of the above referenced Prescribed Countries please provide the following confirmations/documentation:

1. Full name of the pension scheme.

2. Registered legal address of the pension scheme.

3. One of the following:

— Confirmation of registration of the pension scheme (as appropriate) from the relevant tax authorities or pensions board.

— Confirmation of the identity of two Trustees/Directors/Governors/Board Members or equivalent of the pension scheme and the constitutional/formation document of the pension scheme.


4. Details of the scheme administrator and the entity carrying out AML/CTF controls on scheme investors.

5. Letter of assurance from the entity carrying out AML/CTF controls on scheme investors.




APPLICATION FORM


COLLECTIVE INVESTMENT SCHEMESWhere the applicant is a Collective Investment Scheme listed on a regulated financial market in an EEA (European Economic Area) State or a regulated financial market in a place other than an EEA State, being a place that imposes on companies whose securities are admitted to trading on the market disclosing requirements consistent with legislation of the European Communities.

1. Please provide proof of listing.

Where the applicant is a Collective Investment Scheme regulated as a designated person from one of the above referenced Prescribed Countries:


Where the Collective Investment Scheme (‘CIS’) is not either listed on a regulated financial market (as above) or regulated as a designated person in one of the above referenced Prescribed Countries please provide the following confirmations/documentation:

1. Full name of the CIS.

2. Registered address of the CIS.

3. Prospectus or equivalent of the CIS.

4. Name and address of the promoter of the CIS.

5. Name and address of the administrator of the CIS.

6. Name and address of the entity carrying out due diligence on the investors in the CIS and confirmation that this entity is regulated for AML purposes.

7. Names of any investors (Beneficial Owners) who own more than 25% of the share capital of the CIS.


8. Letter of Assurance from the entity carrying out AML/CTF controls on scheme investors.

9. Due diligence documentation (by reference to the legal form of the entity) for any Beneficial Owner beneficially entitled to more than 25% of the share capital of the CIS.


INDIVIDUALS (INCLUDING JOINT ACCOUNT HOLDERS)Where the applicant is an Individual please provide the following documentation:

1. Photographic identity document.

2. Proof of address.

3. One of the following:

— An additional verification document such as a second photographic identity document or a second proof of address document.

— Confirmation from a credit or financial institution confirming that the applicant is or has been a customer of that institution.

In the case of joints account holders, please provide documents in respect of all holders.




APPLICATION FORM


PRIVATE AND UNLISTED COMPANYWhere the applicant is a Private Company/Company not listed on a regulated financial market please provide the following confirmations/documentation:

1. Full name of the Company.

2. Registered number of the Company.

3. Registered legal address and principal business address of the Company.

4. Details of the directors of the Company.


6. Details of any beneficial owners who own more than 25% of the share capital, profit or voting rights or exercise control over management of the company.



— Extract from the relevant company registry providing details of the Company; and/or

— Copy of the certificate of incorporation or equivalent of the Company; and/or

— Copy of the Memorandum and Articles of Association or equivalent of the Company; and/or

— Copy of the latest audited financial statements of the Company.


8. Due diligence documentation (by reference to the legal form of the entity) for any Beneficial Owner beneficially entitled to more than 25% of the share capital of the Company.


LIMITED LIABILITY COMPANYWhere the applicant is a Limited Liability Company (LLC) please provide the following confirmations/ documentation:

1. Full name of the LLC.

2. Registered legal address and principal business address of the LLC.

3. Details of the managing members of the LLC.

4. Photographic identity document and proof of address for 2 managing members or 1 managing member and one authorised signatory of the LLC.

5. Details of any Beneficial Owner of the LLC.


6. Constitutional document for the LLC (e.g. certificate of incorporation).

7. Operating agreement for the LLC.



APPLICATION FORM



8. Photographic identity document and proof of address for 2 managing members of the LLC.

9. Due diligence documentation (by reference to the legal form of the entity) for any Beneficial Owner beneficially entitled to more than 25% of the share capital of the LLC.


PARTNERSHIPWhere the applicant is a Partnership Fund the following confirmation/documentation should also be provided:

1. Full name of the Partnership.

2. Registered legal address and principal business address of the Partnership.

3. Details of the partners.

4. Details of the general partner of the Partnership Fund and due diligence documentation for such general partner (by reference to the legal form of such general partner).

5. Photographic identity document and proof of address for 2 partners or one partner and one authorised signatory.

6. Details of any Beneficial Owner of the Partnership.


7. Constitutional document for the Partnership (e.g. Partnership Agreement).

Where the applicant is not a Partnership Fund or located in one of the aforementioned deemed high risk jurisdictions, the following documentation should also be provided:

1. Full name of the Partnership.

2. Registered legal address and principal business address of the Partnership.

3. Details of the partners.

4. Photographic identity document and proof of address for 2 partners or one partner and one authorised signatory.

5. Details of any Beneficial Owner of the Partnership.


6. Constitutional document for the Partnership (e.g. Partnership Agreement).

7. Due diligence documentation (by reference to the legal form of the entity) for any Beneficial Owner beneficially entitled to more than 25% of the share capital of the Partnership.




APPLICATION FORM


TRUSTWhere the applicants are Regulated Trustees investing on behalf of a Trust or similar entity, please provide the following confirmations/documentation (only applicable for Trustees not located in a high risk jurisdiction):

1. Full name of the Trust.

2. Registered address of the Trust.

3. Confirmation of the legal form of the Trust.

4. Trust deed or equivalent or confirmation by reference to an appropriate register.

5. Confirmation of the nature/purpose of the Trust.

6. Confirmation of the trustees of the Trust with proof of regulation for the trustees.

7. Details of any Beneficial Owner of the Trust.


8. Details of the settlor of the Trust.

9. Details of the protector (where such protector has been appointed) for the Trust.

Where the applicants are not Regulated Trustees investing on behalf of a Trust, the following confirmations/ documentation should be provided:

1. Full name of the Trust.

2. Registered address of the Trust.

3. Confirmation of the legal form of the Trust

4. Trust deed or equivalent for the Trust.

5. Confirmation of the nature/purpose of the Trust.

6. Confirmation of the trustees of the Trust.

7. Photographic identity document and proof of address for 2 trustees or 1 trustee and 1 authorised signatory.

8. Details of any Beneficial Owner of the Trust.


9. Details of the settlor of the Trust.

10. Photographic identity document and proof of address for the settlor of the Trust.

11. Details of the protector (where such protector has been appointed) for the Trust.

12. Photographic identity document and proof of address for the protector (if any) of the Trust.

13. Photographic identity document and proof of address for the beneficiaries who hold more than 25% of the beneficial interest, where practicable.




APPLICATION FORM


FOUNDATIONWhere the applicants are Regulated Trustees investing on behalf of a Foundation, please provide the following confirmations/documentation (only applicable for Trustees not located in a high risk jurisdiction):

1. Full name of the Foundation or similar entity.

2. Registered address of the Foundation.

3. Confirmation of the legal form of the Foundation.

4. Constitutional documents or confirmation of the Foundation by reference to an appropriate register

5. Confirmation of the nature/purpose of the Foundation.

6. Confirmation of the trustees of the Foundation with proof of regulation for the trustees.

7. Details of any Beneficial Owner of the Foundation.


Where the applicants are not Regulated Trustees investing on behalf of a Foundation or similar entity, the following confirmations/documentation should be provided:

1. Full name of the Foundation.

2. Registered address of the Foundation.

3. Confirmation of the legal form of the Foundation.

4. Trust deed or equivalent for the Foundation.

5. Confirmation of the nature/purpose of the Foundation.

6. Confirmation of the trustees of the Foundation.

7. Photographic identity document and proof of address for 2 directors/ trustees or 1 director/ trustee and 1 authorised signatory.

8. Details of any Beneficial Owner of the Foundation.




CHARITYWhere the applicant is a registered Charity please provide the following confirmations/documentation:

1. Full name of the Charity.

2. Registered legal address and principal business address of the Charity.

3. Confirmation of the nature/purpose of the Charity with details of how the Charity is funded.

4. (As applicable) extract from the relevant charities register (e.g. UK Charities Commission).



APPLICATION FORM


Where the applicant is not a registered Charity please provide the following confirmations/documentation:

1. Full name of the Charity.

2. Registered legal address and principal business address of the Charity.

3. Confirmation of the nature/purpose of the Charity with details of how the Charity is funded.

4. Details of the Trustees/Directors/Governors/Board Members of the Charity.

5. Photographic identity document and proof of address for 2 Trustees/Directors/Governors/Board Members of the Charity.

6. Details of the beneficiaries of the Charity.


7. Constitutional/formation document of the Charity.

8. Audited financial statements for the Charity.


NOTE Where the applicant is not a registered Charity, documentation provided should be certified as true copies of the original documentation.

CLUB OR SOCIETYWhere the applicant is a Club or Society please provide the following confirmations/documentation:

1. Full name of the Club/Society.

2. Registered legal address and principal business address of the Club/Society.

3. Confirmation of the legal status of the Club/Society.

4. Confirmation of the nature/purpose of the Club/Society with details of how the Club/Society is funded.

5. Details of the principal Officers of the Club/Society.

6. Photographic identity document and proof of address for 2 principal Officers of the Club/Society or 1 principal officer and 1 authorised signatory certified as true copies of the original documents.

7. Constitutional/formation document or Audited financial statements for the Club/Society.


8. Audited financial statements for the Club/Society.

9. Details of any Beneficial Owner with photographic identity document and proof of address for such Beneficial Owner(s) who own or control over 25% of the entity’s share capital, profit or voting rights.


SCHOOL, COLLEGE OR UNIVERSITYWhere the applicant is a School, College or University please provide the following confirmations/documentation:

1. Full name of the School, College or University.

2. Registered legal address and principal business address of the School, College or University.



APPLICATION FORM


3. Background information on the School, College or University and confirmation of the legal status of the School, College or University.

4. Confirmation of the nature/purpose of the School, College or University with details of how the School, College or University is funded.

5. Details of the principal Officers of the School, College or University.

6. Photographic identity document and proof of address for 2 principal Officers or 1 principal office and 1 authorised signatory of the School, College or University.

7. Details of the ownership of the School, College or University including whether the School, College or University is in public or independent ownership. Where independently owned, identify all persons who own or control over 25% of the entity’s share capital, profit or voting rights.


8. Photographic identity document and proof of address for any Beneficial Owner(s) who own or control over 25% of the entity’s share capital, profit or voting rights in line.


CHURCHWhere the applicant is a Church please provide the following confirmations/documentation:

1. Full name of the Church.

2. Registered legal address and principal business address of the Church.

3. Confirmation of the nature/purpose of the Church with details of how the Church is funded.

4. Complete a check of a relevant church register or source a copy of the revenue approval for the church;

OR

5. Details of the Trustees/Directors/Governors/Board Members of the Church.

6. Photographic identity document and proof of address for 2 Trustees/Directors/Governors/Board Members of the Church.

7. Details of the beneficiaries of the Church.

8. Constitutional/formation document of the Church.


9. Audited financial statements for the Church.

10. Details of any Beneficial Owner with photographic identity document and proof of address for such Beneficial Owner(s).


TRADE UNIONWhere the applicant is a Trade Union please provide the following confirmations/documentation:

1. Full name of the Trade Union.

2. Registered legal address and principal business address of the Trade Union.



APPLICATION FORM


3. Confirmation of the legal status of the Trade Union including whether the Trade Union is registered or otherwise listed by a controlling body for regulatory or oversight purposes (e.g. Congress of Trade Unions).

4. Confirmation of the stated purpose, aims and objectives of the Trade Union with also details of how the Trade Union is funded.

5. Details of the Officers of the Trade Union empowered to make investments on behalf of the Trade Union (e.g. president, secretary, treasurer or other senior committee members).

6. Constitutional/formation document of the Trade Union.


7. Photographic identity document and proof of address for 2 principal Officers of the Trade Union.


REPRESENTATIONS AND WARRANTIES — I/We confirm that I am/we are 18 years of age or over.

— I/We, having received and considered a copy of the current Prospectus, any relevant supplements thereto and the most recent annual and/or semi-annual report of the ICAV (if any), hereby confirm and declare that this application is based solely on the information contained in such documentation and is made pursuant to the terms of this Application Form, and acknowledge that it is subject to Irish law.

— In addition, I/We confirm that I/We have received and read the information contained in this form and confirm that a copy of the relevant KIID or KIIDs has/have been supplied to me/us. I/We confirm that I/We have read the relevant KIID or KIIDs and that any future investments to any other sub-fund or Share Class of the umbrella fund can also be transacted based on this confirmation. I/We hereby acknowledge and agree that the updated relevant KIID or KIIDs for each Share Class is/are available at the Investment Manager’s website at gqgpartners.com/products/ucits/ and that I/we will read and review the most up-to-date version of the relevant KIID or KIIDs prior to making any subsequent application for Shares in the ICAV. I/We request and authorise GQG Partners LLC to act in accordance with my/our instructions.

— I/We certify that I am/we are eligible to invest in the ICAV, the relevant Fund or Share Class therof, and I am/we are not acquiring Shares for or on behalf of, or for the benefit of, any person or entity who/which is not eligible to invest in the ICAV, the relevant Fund or Share Class therof, nor do I/we intend transferring any Shares which I/we may purchase to any person or entity who/which is not eligible to invest in the ICAV, the relevant Fund or Share Class therof. I/We confirm that I/we are aware of the risks involved in the proposed investment and of the fact that inherent in such investment is the potential to lose the entire sum invested.

— I/We agree to notify the ICAV or the Administrator immediately if I/we become aware that any of the representations, declarations or warranties given by me/us in this Application Form is/are no longer accurate and complete in all respects and agree immediately to take such action as the ICAV may direct, including where appropriate, redemption of my/our entire holding.

— I/We agree to indemnify the Administrator, on its own behalf and as agent of the ICAV and agree to keep the Administrator and the ICAV indemnified against any loss of any nature whatsoever arising to any of them as a result of any breach of any of the representations, warranties or declarations given by me/us in this Application Form.

— I/We have such knowledge and experience in business and financial matters or have obtained advice from a professional adviser such that I am/we are capable of evaluating the merits, and the risks, of an investment by me/us in the ICAV.

https://gqgpartners.com/https://gqgpartners.com/products/ucits/https://gqgpartners.com/products/ucits/


APPLICATION FORM


— I/We understand that the tax disclosure set forth in the Prospectus is of a general nature and may not cover the jurisdiction in which I am/we are subject to taxation and that the tax consequences of my/our purchase of Shares depend on my/our individual circumstances.

— I/We acknowledge the right of ICAV at any time to require the mandatory redemption of Shares in the circumstances provided for in the Prospectus.

— Please tick () as appropriate:

» I/We hereby certify that the Shares are not being acquired for the benefit of, directly or indirectly, any U.S. Person nor in violation of any applicable law, and that I/we will not, subject to the conditions set forth in the Prospectus, sell or offer to sell or transfer Shares in the United States or to or for the benefit of a U.S. Person.

In particular: (a) I/we understand that the ICAV has not been and will not be registered under the United States Investment Company Act of 1940, as amended, that the Shares have not been registered and will not be registered under the United States Securities Act of 1933, as amended, and that the Shares have not been qualified under the securities laws of any state of the United States and may not be offered, sold or transferred in the United States or to or for the benefit of, directly or indirectly, any U.S. Person; (b) I am not/none of us is a U.S. Person; and (c) I am not/none of us is acquiring the Shares for the account or benefit, directly or indirectly, of any U.S. Person or with a view to their offer, sale or transfer within the United States or to or for the account or benefit, directly or indirectly, of any U.S. Person.

Prospective investors who are unable to give this certification should contact their investment advisor or GQG Partners client service team for details on other GQG products they may be eligible to invest in.

» I/We, if not a natural person, am/are duly organised, validly existing and in good standing under the laws of the jurisdiction in which I am/we are organised and I/we have the power and authority to enter into and perform my/our obligations under this Application Form.

» I/We am/are able to bear the economic risk of an investment in the Shares, including, without limitation, the risk of loss of all or a part of my/our investment. I/We do not have an overall commitment to investments which are not readily marketable that is disproportionate to my/our net worth, and my/our investment in the Shares will not cause such overall commitment to be excessive.

» The Administrator and the ICAV are each hereby authorised and instructed to accept and execute any instructions in respect of the Shares to which this application relates given by me/us in written form or by facsimile. I/We hereby agree to indemnify the Administrator, on its own behalf and as agent of the ICAV and agree to keep the Administrator indemnified against any loss of any nature whatsoever arising as a result of the Administrator acting upon facsimile instructions. The Administrator may rely conclusively upon and shall incur no liability in respect of any action taken upon any notice, consent, request, instruction or other instrument believed in good faith to be genuine or to be signed by properly authorised persons.

» I/We acknowledge that due to anti-money laundering requirements operating within Ireland, the Administrator or the ICAV (as the case may be) may require further identification of the applicant(s) before the application can be processed and the Administrator, on its own behalf and as agent of the ICAV and the ICAV shall be held harmless and indemnified against any loss arising as a result of a failure to process the application, or a delay in processing any redemption requests, if such information requested by the Administrator or the ICAV has not been provided by me/us or has been provided in incomplete form.

» In respect of joint applicants only, we direct that on the death of one of us the Shares for which we hereby apply be held in the name of and to the order of the survivor or survivors of us or the executor or administrator of the last of such survivor or survivors.

» I/We consent to personal information obtained in relation to me/us being processed by the Administrator, the ICAV, the Depositary, the Distributor or the Investment Manager and their agents, affiliates, delegates



APPLICATION FORM


and group companies in accordance with the Data Protection Legislation. I/We acknowledge that information, including personal data, in relation to me/us will be held, used, disclosed and processed as set out in Appendix I for the purposes cited therein, including for the purposes of (a) managing and administering my/our holdings in the ICAV and any related account on an ongoing basis; (b) for any other specific purposes where I/We have given specific consent to do so; (c) to carry out statistical analysis and market research; (d) to comply with any applicable legal, tax or regulatory obligations including legal obligations under company law, tax law and anti-money laundering legislation; (e) for disclosure and transfer whether in Ireland or elsewhere (including companies situated in countries outside of the European Economic Area which may not have the same data protection laws as in Ireland) to third parties including my/our financial adviser (where appropriate), regulatory bodies, taxation authorities, auditors, technology providers or to the ICAV and its delegates and its or their duly appointed agents and any of their respective related, associated or affiliated companies for the purposes specified above; (f) and for other legitimate business interests of the ICAV or its delegates.

» I/We hereby acknowledge my/our right of access to and the right to amend, erase, transfer and rectify my/our personal data, as provided herein in accordance with the Data Protection Legislation.

» I/We understand that the ICAV is a data controller, and certain of its service providers also are, and will hold any personal information provided by me/us in confidence and in accordance with the Data Protection Legislation.

» I/We consent to the recording of telephone calls that I/we make to and receive from the Administrator, the ICAV, the Distributor or the Investment Manager and their delegates or duly appointed agents and any of their respective related, associated or affiliated companies for record keeping, security and/or training purposes.

» I/We hereby authorise the ICAV and the Administrator to retain all documentation provided by me/us in relation to my/our investment in the ICAV for such period of time as may be required by Irish law, but for not less than five years after the period of investment has ended.

» The Administrator or ICAV may disclose personal information to the Depositary and/or the Investment Manager and/or third parties where necessary or for legitimate business interests. This may include disclosure to third parties such as auditors and the Central Bank of Ireland or agents of the Administrator who process the personal information for anti-money laundering purposes or for compliance with foreign regulatory requirements. The Administrator may and will hold all or part of the personal information in relation to your shareholding in accordance with legal and regulatory requirements even after you have fully redeemed from the Fund.

» I/We consent to the processing of my/our information and the disclosure of my/our information as outlined above and to the Investment Manager and where necessary or in the Fund’s legitimate interests to any company in the Investment Manager’s group of companies or agents of the ICAV including companies situated in countries outside the European Economic Area, which may not have the same data protection laws as in Ireland.

» I/We consent to the ICAV, Distributor or the Investment Manager sending information about other investment services to me/us by letter, telephone or other reasonable means of communication.

» I/We understand that I/we have a right not to receive such information. Please tick here to NOT receive such information and/or marketing material:

» From time to time, the Investment Manager may send me/us information about other products or services which they offer. I/we have a right not to receive such information. Please tick here to NOT receive such information and/or marketing material:

» By checking this box, I/we confirm that I/we have read, acknowledge and accept the Data Protection Notice set out in Appendix I to this form.



APPLICATION FORM


— I/We agree to provide to the Fund, the Manager and the Administrator at such times as each of them may request such declarations, certificates, self-certification forms, withholding statements or documents as each of them may reasonably require (the “Tax Information”) in connection with this investment (including for the purposes of tax, FATCA and/or CRS regulations and reporting requirements). Should any information furnished to any of them become inaccurate or incomplete in any way, I/we hereby agree to notify the Fund, the Manager or the Administrator immediately of any such change and further agree to request the redemption of Shares in respect of which such confirmations have become incomplete or inaccurate where requested to do so by the Fund.

— In addition to the Tax Information, I/we agree to promptly provide, and periodically update, at any times requested by the Manager or the Administrator with any information (or verification thereof) the Manager or the Administrator deems necessary for the ICAV to comply with tax reporting requirements, FATCA and/or CRS (including any imposed by any inter-governmental agreement (IGA) or any legislation, law, regulation or other official guidance in relation to any IGA on the implementation of FATCA or CRS). This may include such information as is required to evidence the Fund’s (or any account holder in the Fund’s) status for FATCA or CRS purposes, including (but not limited to) whether the ICAV is a financial institution, or whether its account holders are U.S. persons for purposes of FATCA, or what the account holder’s country of tax residence for purposes of CRS.

— I/We represent and warrant the completeness and accuracy of any information (as at the date of submission) and authorise the Fund, the Manager and the Administrator to act upon such information in good faith, including, but not limited to, disclosing or submitting such information to the Irish tax authorities. I/We agree to waive any provision of foreign law that would, absent such a waiver, prevent compliance with such requirements. The ICAV shall have no obligation to carry out any investigation with respect to the truth, accuracy or completeness of any information provided by us and I/we will, on demand, hold the ICAV harmless from any liability resulting from my/our failure to provide complete and accurate Information.

— I/We hereby acknowledge that if I/we fail to provide any information on a timely basis, I/we may be subject to 30% U.S. withholding tax on the investor’s share of “withholdable payments” (as defined for purposes of FATCA) received by the Fund.

— I/We hereby acknowledge that if I/we fail to provide any information and such failure results in the ICAV being unable to comply with FATCA, any IGA or CRS, the Manager may exercise its right to completely redeem an applicant (at any time upon any or no notice). I/We further acknowledge and agree to indemnify the ICAV and its other investors for any losses resulting from my/our failure to meet its obligations under this Section, including any U.S. withholding tax imposed on the Fund.

— I/We hereby acknowledge that any notice or document may be served by the ICAV or Administrator on me/us in the manner specified from time to time in the Prospectus and, for the purposes of the Electronic Commerce Act 2000, if I/we have provided an e-mail address or fax number to the ICAV or its delegate, consent to any such notice or document being sent to me/us by fax or electronically to the fax number or e-mail address previously identified to the ICAV or its delegate which I/we acknowledge constitutes effective receipt by me/us of the relevant notice or document. I/We acknowledge that I/we am/are not obliged to accept electronic communication and may at any time choose to revoke my/our agreement to receive communications by fax or electronically by notifying the ICAV in writing at the above address, provided that my/our agreement to receive communications by fax or electronically shall remain in full force and effect pending receipt by the ICAV of written notice of such revocation.

— Where I/we am/are investing as nominee, I/we shall provide my/our client(s) with the KIID issued in respect of the Sub-Fund and/or Share Class (as the case may be) and I/we shall ensure that we do so in compliance with Commission Regulation (EU) No. 583/2010, as amended from time to time or by any supplemental legislation and in compliance with the applicable legislation in any jurisdiction in carrying out this activity. I/We shall maintain records of my/our provision of the KIID to my/our clients and shall furnish such records to the Fund, or its delegates, upon request.



APPLICATION FORM


— I/We understand that the ICAV is susceptible to operational and information security risks through breaches in cyber security. Cyber security breaches include, without limitation, infection by computer viruses and gaining unauthorised access to the computer’s systems through “hacking” or other means for the purpose of misappropriating assets or sensitive information, corrupting data, or causing operations to be disrupted. Cyber security breaches may also occur in a manner that does not require gaining unauthorised access, such as denial-of-service attacks or situations where authorised individuals intentionally or unintentionally release confidential information stored on the Company’s systems. A cyber security breach may cause disruptions and impact the Company’s business operations, which could potentially result in financial losses, inability to determine a fund’s NAV, violation of applicable law, regulatory penalties and/or fines, compliance and other costs. I/We understand that indirect cyber security breaches at third party service providers may also generate the same risks associated with direct cyber security breaches for the investment. Further, indirect cyber security breaches at an issuer of securities in which the Company invests may similarly negatively impact it.

— I/We hereby confirm that this Application Form is/is not being made by a Politically Exposed Person (“PEP”)/immediate family member of a PEP/close associate of a PEP and that I/we do/do not have a beneficial owner who is a PEP/immediate family member of a PEP/close associate of a PEP and this Application Form is/is not being made for the benefit of a PEP/immediate family member of a PEP/close associate of a PEP and it is/is not intended to transfer the Shares to a PEP/immediate family member of a PEP/close associate of a PEP.

— I/We hereby authorise investigation of my/our identity, and agree to an enhanced ongoing monitoring should I/we be deemed to be a Politically Exposed Person. Politically Exposed Persons are defined as “natural persons who are or have been entrusted with prominent public functions within the past year, as well as immediate family members, or persons known to be close associates, of such persons”.



APPLICATION FORM


DECLARATION OF RESIDENCE OUTSIDE IRELAND*Applicants resident outside Ireland are required by the Irish Revenue Commissioners to make the following declaration which is in a format authorised by them, in order to receive payment without deduction of tax. It is important to note that this declaration, if it is then still correct, shall apply in respect of any subsequent acquisitions of Shares. Certain terms used in this declaration are defined in the Prospectus.

DECLARATION ON OWN BEHALF

I/We* declare that I am/we are* applying for the Shares on my own/our own behalf/on behalf of a company* and that I am/we are/the company is* entitled to the Shares in respect of which this declaration is made and that:

— I am/We are/The company is* not currently resident or ordinarily resident in Ireland, and

— Should I/we/the company* become resident in Ireland I will/we will/the company will* so inform you, in writing, accordingly.

*Choose as appropriate (mandatory)

DECLARATION AS INTERMEDIARY

I/We* declare that I am/we are* applying for Shares on behalf of persons:

— who will be beneficially entitled to the Shares; and,

— who, to the best of my/our* knowledge and belief, are neither resident nor ordinarily resident in Ireland.

I/We* also declare that:

— unless I/we* specifically notify you to the contrary at the time of application, all applications for Shares made by me/us* from the date of this application will be made on behalf of such persons; and,

— I/we* will inform you in writing if I/we* become aware that any person, on whose behalf I/we* hold Shares, becomes resident in Ireland.

*Choose as appropriate (mandatory)

Name and address of applicant:

Signature of applicant or authorised signatory: (declarant)

Capacity of authorised signatory (if applicable): Date:

JOINT APPLICANTS

Names: Signatures:

IMPORTANT NOTES1. Non-resident declarations are subject to inspection by the Irish Revenue Commissioners and it is a criminal offence to make a false declaration.2. To be valid, the application form (incorporating the declaration required by the Irish Revenue Commissioners) must be signed by the applicant.

Where there is more than one applicant, each person must sign. If the applicant is a company, it must be signed by the company secretary or another authorised officer.

3. If the application form (incorporating the declaration required by the Irish Revenue Commissioners) is signed under power of attorney, a copy of the power of attorney must be furnished in support of the signature.



APPLICATION FORM


DECLARATION OF RESIDENCE WITHIN IRELAND1 DECLARATION REFERRED TO IN SECTION 739D(6) TAXES CONSOLIDATION ACT, 1997It is important to note that this declaration, if it is then still correct, shall apply in respect of any subsequent acquisitions of Shares.

I declare that the information contained in this declaration is true and correct.

I also declare that I am applying for the Shares on behalf of the applicant named below who is entitled to the Shares in respect of which this declaration is made and is a person referred to in Section 739D(6) of the Taxes Consolidation Act, 1997, being a person who is (please tick as appropriate):

A pension scheme

A company carrying on life business within the meaning of section 706 TCA 1997

An investment undertaking

An investment limited partnership

A special investment scheme

A unit trust to which section 731(5)(a) TCA 1997 applies

A charity being a person referred to in section 739D(6)(f)(i) TCA 1997

A qualifying management company

Entitled to exemption from income tax and capital gains tax by virtue of sections 784A(2) TCA 1997 (see further requirements for Qualifying Fund Manager below)

A PRSA Administrator

A credit union to which Section 2 of the Credit Union Act, 1997 applies

Additional requirement where the declaration is completed on behalf of a pension scheme, a company carrying on life business within the meaning of section 706 TCA 1997, an investment undertaking, an investment limited partnership, a special investment scheme, a unit trust to which section 731(5)(a) TCA 1997 applies, a qualifying management company or a credit union to which Section 2 of the Credit Union Act 1997 applies:

I undertake that, in the event that the Shares cease to be assets of the pension scheme/company carrying on life business within the meaning of section 706 TCA 1997/investment undertaking/investment limited partnership/special investment scheme/unit trust to which section 731(5) (a) TCA 1997 applies/qualifying management company/credit union to which Section 2 of the Credit Union Act 1997 applies*, including a case where the Shares are transferred to another such entity, I will, by written notice, bring this fact to the attention of the investment undertaking accordingly. (*Choose as appropriate.)

Additional requirements where the declaration is completed on behalf of a Charity:

I also declare that at the time of making this declaration, the Shares in respect of which this declaration is made are held for charitable purposes only and;

Form part of the assets of a body of persons or trust related by the Revenue Commissioners as a body or trust established for charitable purposes only, or are, according to the rules or regulations established by statute, charter, decree, deed of trust or will, held for charitable purposes only and are so treated by the Revenue Commissioners.

I undertake that, in the event that the person referred to in paragraph (7) of Schedule 2B TCA 1997 ceases to be a person referred to in Section 739D(6)(f)(i) TCA 1997, I will by written notice, bring this fact to the attention of the investment undertaking accordingly.

1Only applicable to Irish domiciled funds. Client’s Irish tax advisors should confirm that content mirrors the Irish Revenue’s Prescribed Forms.



APPLICATION FORM


Additional requirements where the declaration is completed by a Qualifying Fund Manager/PRSA Administrator:

I also declare that at the time this declaration is made, the Shares in respect of which this declaration is made;

Are assets of an approved retirement fund/an approved minimum retirement fund/PRSA*, and

Are managed by the declarant for the individual named below who is beneficially entitled to the Shares.

I undertake that, if the Shares cease to be assets of the approved retirement fund/the approved minimum retirement fund/PRSA*, including a case where the Shares are transferred to another such fund or account, I will, by written notice, bring this fact to the attention of the investment undertaking accordingly. (*Choose as appropriate.)

I/We* also declare that:

unless I/we* specifically notify you to the contrary at the time of application, all applications for Shares made by me/us* from the date of this application will be made on behalf of persons referred to in section 739D(6) TCA 1997; and

I/we* will inform you in writing if I/we* become aware that any person ceases to be a person referred to in section 739D(6) TCA 1997. (*Choose as appropriate.)

Name of applicant:

Irish Tax Reference Number of Applicant:

Authorised signatory:

Capacity in which declaration is made: Date:

IMPORTANT NOTES1. This is a form authorised by the Revenue Commissioners which may be subject to inspection. It is an offence to make a false declaration.2. Tax reference number in relation to a person, has the meaning assigned to it by Section 885 TCA 1997 in relation to a “specified person” within

the meaning of that section. In the case of a charity, quote the Charity Exemption Number (CHY) as issued by Revenue. In the case of a qualifying fund manager, quote the tax reference number of the beneficial owner of the Shares.

3. In the case of (i) an exempt pension scheme, the administrator must sign the declaration (ii) a retirement annuity contract to which Section 784 or 785 applies, the person carrying on the business of granting annuities must sign the declaration (iii) a trust scheme, the trustees must sign the declaration. In the case of a charity, the declaration must be signed by the trustees or other authorised officer of a body of persons or trust established for charitable purposes only within the meaning of Sections 207 and 208 TCA 1997. In the case of an approved retirement fund/an approved minimum retirement fund or PRSA, it must be signed by a qualifying fund manager or PRSA Administrator. In the case of an intermediary, the declaration must be signed by the intermediary. In the case of a company, the declaration must be signed by the company secretary or other authorised officer. In the case of a unit trust it must be signed by the trustees. In any other case, it must be signed by an authorised officer of the entity concerned or a person who holds a power of attorney from the entity. If the latter, a copy of the power of attorney should be furnished in support of this declaration.

SIGNATUREI/We declare that the information contained in this form and any attached documentation is true and accurate to the best of my/our knowledge and belief.

Date:

Signed:

1.

2.

3.

4.

Signatory Capacity if applicable (i.e. Director/manager):

IN THE CASE OF ALL JOINT HOLDERS — ALL HOLDERS MUST COMPLETE THIS DECLARATION.



APPLICATION FORM


ENTITY SELF-CERTIFICATION FOR FATCA AND CRS Instructions for completion and Data Protection notice

We are obliged under Section 891E, Section 891F, and Section 891G of the Taxes Consolidation Act 1997 (as amended) and regulations made pursuant to those sections to collect certain information about each account holder’s tax arrangements. Please complete the sections below as directed and provide any additional information that is requested. Please note that by completing this application form you are providing personal information, which may constitute personal data within the meaning of the General Data Protection Regulation (697/2016/EU) (the “GDPR”) and applicable Irish data protection legislation (currently the Irish Data Protection Acts 1988 to 2003). Please note that in certain circumstances we may be legally obliged to share this information, and other financial information with respect to an account holder’s interests in the Fund, with the Irish tax authorities, the Revenue Commissioners. They in turn may exchange this information, and other financial information with foreign tax authorities, including tax authorities located outside the EU.

If you have any questions about this form or defining the account holder’s tax residency status, please speak to a tax adviser or local tax authority.

For further information and guidance on FATCA or CRS please refer to the Irish Revenue or the OECD website at:http://www.revenue.ie/en/business/aeoi/index.html http://www.oecd.org/tax/automatic-exchange/common-reporting-standard/ in the case of CRS only.

If any of the information below about the account holder’s tax residence or FATCA/CRS classification changes in the future, please ensure that we are advised of these changes promptly.

Account holders that are Individuals or Controlling Persons should not complete this form and should complete the form entitled “Individual (including Controlling Persons) Self-Certification for FATCA and CRS”.

(Mandatory fields are marked with an *)

SECTION 1: ACCOUNT HOLDER IDENTIFICATION*

Account Holder Name*: (the “Entity”)

Country of Incorporation or Organisation*:

Current (Resident or Registered) Address*:

Number: Street:

City, Town, State, Province or County:

Postal/ZIP Code: Country:

Mailing Address (if different from above):

Number: Street:

City, Town, State, Province or County:

Postal/ZIP Code: Country:

https://gqgpartners.com/http://www.revenue.ie/en/business/aeoi/index.htmlhttp://www.oecd.org/tax/automatic-exchange/common-reporting-standard/


APPLICATION FORM


SECTION 2: FATCA DECLARATION*

Please tick either (A), (B) or (C) below and complete as appropriate.

(A) The Entity is a Specified U.S. Person and the Entity’s U.S. Federal Taxpayer Identifying number (U.S. TIN) is as follows:

U.S. TIN: OR

(B) The Entity is not a Specified U.S. Person (Please also complete Sections 3, 4 and 5) OR

(C) The Entity is a U.S. person but not a Specified U.S. Person (Please also complete Sections 4 and 5)

Indicate exemption:

SECTION 3: ENTITY’S FATCA CLASSIFICATION*

The information provided in this section is for FATCA, please note your FATCA classification may differ from your CRS classification in Section 5.

3.1 Financial Institutions under FATCA

If the Entity is a Financial Institution, please tick one of the below categories and provide the Entity’s GIIN at 3.2 or indicate at 3.3 the reason why you are unable to provide a GIIN.

I. Irish Financial Institution or a Partner Jurisdiction Financial Institution.

II. Registered Deemed Compliant Foreign Financial Institution.

III. Participating Foreign Financial Institution.

3.2 Please provide the Entity’s Global Intermediary Identification number (GIIN)

. . .

3.3 If the Entity is a Financial Institution but unable to provide a GIIN, please tick one o